The four or five consistent readers of this blog may have noticed that it’s been a while since I’ve posted anything. There’s a reason for that. How about I share it with you in story form? It starts with “Once upon a time,” but I’m afraid the ending is a bit different from “happily ever after,” at least, for now. I do believe that will be the ending, eventually.
Before I start, let me say that I am telling this story for two reasons, one selfish and one altruistic. First the story, then the reasons.
Warning: as per my usual, this post is long. Really long. (Cut me some slack this time; I’ve got over two weeks of absence to make up for.) Read it in pieces if need be. Go get yourself a cup of coffee halfway through and come back. If you’re a cubicle-dweller and I’ve given you a way to kill some time at work, you’re welcome. ;-)
Once upon a time, there was a woman who struggled with many health problems, large and small, acute and chronic. She was an insulin-dependent type-2 diabetic for almost thirty years, and poor blood sugar control coupled with the endless stress and sleep deprivation that came with running a business and raising two children resulted in a host of ugly complications as time went by. She survived a radical hysterectomy, three very minor strokes, and had a small, slow-growing GIST removed (basically a stomach tumor), with, thankfully, no need for chemotherapy or radiation. Her eyesight was affected by the diabetes, and she experienced a lot of neuropathy, particularly in her feet. Her feet got so bad, in fact, that she had to give up driving about five years ago and lost a great deal of her independence. (She could no longer feel her feet, and even if she could, her reaction time wouldn’t have been fast enough for her to be safe out on the road.) Adding insult to injury, she had experienced many, many issues with her feet that went beyond the loss of feeling. The nutshell version is, she suffered a lot of fractures and breaks of small bones in both feet, most of which did not heal properly, eventually leading to her requiring a custom made, hard plastic, space-age looking boot, in order to force one foot and lower leg into the correct position, and the other leg wasn’t faring much better. Having a rod inserted to stabilize the leg and foot wasn’t an option, as the bone itself had deteriorated so badly that there was nothing there to anchor/attach a rod to. I and other people this woman knew suggested that amputation and a prosthesis would likely improve her quality of life at least somewhat, but understandably, that was a bit too scary for her just yet.
As for the deterioration of the bone, I suspected [and explained as much to her] that it was likely the result of over a decade of prescription acid blocking drugs (she was on a PPI – proton pump inhibitor), which, as I explained here, frequently lead to osteoporosis and pernicious anemia, because we need good, robust stomach acid to liberate minerals from our food and absorb them into the body. (Yes, she also had pernicious anemia, [long-term B12 deficiency], something I, rather than any of her doctors, identified. She had some classic signs: fatigue, depression, tingling and sensation of extreme cold in the hands, plus the bloodwork, which showed signs of improper red blood cell formation. This picture was what I had to go by, since they didn’t bother testing her B12 levels. Given the complete medical history, a friggin’ first year med student [not to mention a nutritionist] could identify that in about six seconds, but oddly, none of this woman’s vast array of doctors ever said a word about the possibility.) In the end, even with the boot on one foot, both feet were so badly deformed that she could barely walk, and for the past couple of years, she got around mostly with the use of a motorized scooter. Her mobility and independence were very compromised. She was overweight as well, and it saddened me to think of all the strangers who might give her a passing glance (or possibly a sneer) and automatically assume that she was in the scooter because of her weight. Obviously, her size didn't make it any easier for her to get around, but that wasn’t the primary reason for the scooter. I knew this woman for 36 years. One thing I can say for sure is that she was not some “lazy, greedy, fat lady.”
Perhaps worse than this woman’s physical health was her emotional state. Of course, these two things are intimately linked, and, in looking at the medical picture, it’s really no surprise that she was depressed, mired in a “woe is me” mindset, and living day to day with not a whole lot more going on than waiting for the proverbial other shoe to drop in terms of medical complications. As I loved this person very, very much, it was difficult to watch this happen. It was painful to watch someone lose their quality of life, and it was even more painful to me because I could (and did!) connect almost every medical issue and complication she experienced to something in her diet, her lifestyle, or the dizzying list of pharmaceutical drugs she was taking. The word “polypharmacy” barely scratches the surface. Who was the genius M.D. who had her on a calcium and magnesium supplement while at the same time on that goddamn PPI? Who was the crackerjack endocrinologist who never once asked her to keep a food log, despite her complaining that her blood glucose seemed to be all over the map regardless of what or how much she ate? Who was the whippersnapper “doctor” who kept loading her up with iron (to no avail) when she seemed to fit the profile for garden-variety anemia until someone else she knew—not an MD, but “just” a nutritionist—told her that she was the freaking poster child for B12 deficiency? Who was the Darwin Award candidate of a doctor who recommended she drink prune juice to stay regular, rather than: 1) trying to figure out why she “needed” prune juice to keep regular in the first place, and 2) suggesting something a little more sensible for a freaking diabetic than prune juice, to the tune of 42 goddamn grams of sugar in an 8-ounce serving?
To be honest, after digging very deeply into this woman’s history, I am not entirely convinced she was diabetic. At least, not at first. Being that despite the insulin, and despite different types of meals, her blood sugar was still all over the map, I did some research that led me to suspect she very likely had sub-clinical Cushing’s disease. In fact, she had 9 out of 11 of the “less common symptoms” and 6 out of the 13 “common symptoms” of Cushing’s. (And of course, Cushing’s causes the body to produce ridiculously large amounts of cortisol, which can wreck blood glucose control regardless of diet.) This woman’s body was a pretty close match for the one pictured here, showing what a Cushing-oid body tends to look like. No doctor ever brought this up, or suggested testing her cortisol levels.
As you can see, this woman was a bit of a health disaster. Some of this was her own doing, and some of it was made worse by sloppy, superficial, and possibly lazy and ignorant allopathic medical care. I would not be honest if I didn’t acknowledge that this woman could (and should!) have taken charge of her health at any point and possibly had a much better outcome. She was completely reactive, rather than proactive. She relied on conventional medical care to help “manage” things after the fact, rather than trying to prevent “stuff” from happening in the first place. And once “stuff” did happen—and boy, was there a lot of it—she mostly resigned herself to it. Resigned herself to the insulin, to the drugs, to the scooter, to whatever it was that might help her continue to function and participate in society in ways made possible only by modern medical technology.
As if all she had been through during the past several years hadn’t been enough, the latest development in this onslaught of a failing body and a flagging spirit was a diagnosis of acute myelomonocytic leukemia, or AML-4. She was diagnosed approximately August 27, 2014. The prognosis was poor from the moment of diagnosis. She was given one month to live. She passed away less than three weeks later, on September 13. Chemotherapy and radiation were absolutely not an option. The doctors explained to her family that in the best case scenario, of an otherwise healthy, young person, the treatment course is extremely aggressive, and comes with only a 20-30% chance of survival. Given this 65-year-old woman’s medical history, already degenerating body, and poor health, she was given a 10-15% chance. (Never mind that she did not on any level have the positive mental attitude and “fighting spirit” that are absolute necessities if someone is to successfully come through chemo and radiation.)
As all dark stories have at least some amount of light, one very good thing to come out of this terrible tale is that this woman’s 69-year-old husband—also overweight and with blood sugar management problems—is now taking his diet and lifestyle much, much more seriously. It’s only been a few weeks, and he has already dropped a noticeable amount of weight, and his blood sugar numbers are getting better every day. This is not surprising, as there is a knowledgeable nutritionist in his family who is helping to educate him, and he is eschewing to a very large degree some of his former favorite go-to starchy, carbohydrate-dense foods. More than once in the past, the nutritionist in the family had sat down with this man and his now late wife, and explained some basic facts about digestion, human metabolism, and fuel partitioning. Each time, both acknowledged that everything the nutritionist said made sense. They had never heard things explained that way, and even though some of what she said flew in the face of everything they “knew” about “healthy diets,” they were going to make some changes. But each time, they did not make those changes. I can’t blame them that much, though. (A little, yes.) The fact is, when I took the time to introduce them to some alternative concepts regarding food, pharmaceutical drugs, and overall health, their cognitive dissonance was so severe that they basically just shut down and pretended to listen just to be nice. (The woman more so than the man. The man really seemed to get it; the problem was making the transition from knowing and understanding to actually doing.)
Anyway, now, having seen what happened to his late wife, the man seems to finally, finally be serious about doing whatever he needs to in order to be around for another twenty-five years or so and see his two grandchildren grow up. Even if that means having hard-boiled eggs instead of his morning bagel, and a late-night cup of decaf minus the half-sleeve of Oreos.
In case you haven’t figured it out yet, the woman in this story
is was my mother, and the man is my
Why am I sharing all this with you? Well, in the intro, I mentioned there was a selfish aspect and an altruistic one. Since I can explain the selfish one more quickly, let’s start there. My mother is gone. Even though I know she’s “here,” and always will be, and that, somehow, she will see and know what I achieve in life and what I make of myself, it is probably my single biggest regret right now that she did not get to see me “come into my own,” professionally speaking. She was proud of me my whole life, even when I couldn’t identify a single thing I had done for her to be proud of. Above all, she wanted me to be happy. Of course, professional success is only one small part of the happiness blueprint, but considering the amount of time we modern Americans typically spend at work, maybe it’s not so small. (I should know… take it from someone who’s spent years in unsatisfying and unfulfilling professional situations.)
After many stops and starts, including two previous graduate programs and a stint in the Air Force, I think I’ve finally found something I really enjoy and might possibly be good at. And my mother’s not here to see it take off, or to see me walk with my head held high, bolstered by the sense of self-worth that comes from doing work I think is valuable and important, and contributing something useful to the world at large. Work that employs my passion as well as my intellect. My formal education as well as my love of writing. My love of good food as well as my curiosity and fascination with biochemistry and physiology. Unfortunately, my mother was all too familiar with the dark cloud of lower-than-low self-esteem and complete lack of self-confidence I live(d) under, as discussed here. She’s not here to see it happen, but I’d like to make myself the person she was already proud of. I’d like to become worthy of the pride she felt for me, instead of ashamed and feeling guilty because I think it was so grossly misplaced.
I have mentioned before that I retain a part-time government job while I build my nutrition practice and make inroads into doing this full-time. Well, it’s been very slow-going. Part of that is simply that it’s not the easiest thing in the world to make a decent living doing this, especially not right from the beginning. These things take time and I just need to keep at it, as I heard about a zillion times in various pep talks from people who had come to pay their respects during the Jewish tradition of shiva. Another part of it is that, as you might have surmised from my relative dearth of links to affiliate sites, e-books, recipe apps, newsletters, programs, and such, I suck at marketing. I am an introvert all the way. (If you’re into the Myers-Briggs stuff, I’m an INFJ, with the I part being pretty much off the chart.) Not that this precludes me from learning how to market myself effectively and use the Internet to my advantage, but let’s just say that networking, mingling, making effervescent small talk, and otherwise getting in people’s faces are not my strong suits. Couple that with a serious case of the Dunning-Kruger effect, and you’ve got a recipe for someone somewhat intelligent and skilled to keep a good amount of great information to herself because she compares herself to experts who’ve been at this for years (decades, in some cases), rather than to the average guy or gal on the street, who is largely ignorant of even the most basic principles, and whom she could probably help vastly improve their physical and emotional health in a way she was unable and will now never be able to help her own mother.
So the selfish part of this long, drawn-out story is that I am open for business. I am currently accepting new clients, and I am also seeking full-time employment in the nutrition and health industry. If you know of (or are!) a physician (to include MDs as well as naturopaths, osteopaths, and chiropractors), a personal trainer, acupuncturist, village shaman, voodoo doctor, or anyone else with an established practice or wellness center, and you are looking to bring on an in-house nutritionist or have someone like-minded to refer people to, please contact me. I am, of course, low-carb, keto, Paleo, Primal, and WAPF-oriented, but more than anything, I’m oriented toward helping people to individualize a diet for their unique and specific needs and goals. Maybe that’s low-carb, maybe it’s not. Maybe it includes gluten, maybe it doesn’t. You get the drift. (Also: just kidding about the village shamans and voodoo doctors. They don’t need to contact me, but thanks anyway!)
I will tell you up front: I am still new to this. I can’t reference case histories from thousands of clients, like Chris Kresser or Robb Wolf. I haven’t given talks all over the world like Nora Gedgaudas. I haven’t experienced 3-digit weight loss like Jimmy Moore, and I don’t have 6-pack abs, like Mark Sisson. (Or is he maintaining an 8-pack now?) As someone kinda sorta just starting out, I too often underestimate my knowledge and downplay my skills, because I look at where those people are today, rather than considering where they started from and how long it took them to get there. This is a losing proposition. After all, you don’t compare yourself to Greg Louganis the first time you jump off a diving board, or to Mario Lemieux the first time you pick up a hockey stick.
So while I can be honest and upfront and let people know I haven’t been doing this for a decade, I think there’s also some good that comes from that. The fact is, being new, I have no preconceived notions about how clients are. I can’t sit down with someone and automatically (and possibly incorrectly) peg them as compliant or non-compliant. I can’t analyze someone’s paperwork and know, for sure, right off the bat (again, possibly incorrectly), that they have a leaky gut, or SIBO, or Hashimoto’s, or a dairy intolerance, without digging deeper. Everyone is a clean slate, and that’s as it should be. I dare say that some practitioners have become somewhat myopic, and when they start to specialize in certain things, they set down the variety of tools available to them in favor of just the hammer, so everything begins to look like a nail, if ya know what I mean. (Not to mention that whatever is en vogue seems to be the knee-jerk assumption: gluten sensitivity, H. pylori overgrowth, adrenal fatigue…there’s a new kid on the block every other week.)
I understand that this non-specialization (for now) makes me kind of a gamble for prospective clients. If you suspect you have a thyroid problem, you want to go directly to “the thyroid guy.” If you think you have a gluten intolerance, why would you see me, when you might be able to get on Dr. Tom O’Bryan’s calendar? But then again, if you’re looking for someone who can sit down with you, in person (or via phone or Skype), and take the time to really listen to you, I’m all ears. If you’re looking for someone who will see you as the individual you are, you can contact me through this site.
How about we end things on the altruistic note? I’ve shared with you here some very unfortunate things about my mother’s health history. And like I mentioned earlier, much of what she experienced was her own doing, either directly, through her diet and lifestyle, or indirectly, by just sort of sitting back and letting things happen, rather than taking the reins and trying to do something to prevent those things from happening, or trying to reverse them once they did. (I do not mean the cancer when I say this. I am a huge fan of the research Drs. Thomas Seyfried, Dom D’Agostino, and Colin Champ are doing with regard to mitochondrial dysfunction, ketogenic diets and cancer, and I believe it’s absolutely paradigm-changing, but the fact is, little kids get cancer. Seemingly healthy, fit people with great diets get cancer. Cancer is a vile, vicious beast that, to a great degree, attacks indiscriminately. So I can’t necessarily say that anything in my mother’s diet or lifestyle caused the cancer, but I can speculate that had she been in much better health from the other stuff, she might have been in a better position to fight it.)
That being said, there were reasons my mother wasn’t more proactive about her health. Yes, she was overweight, but in my not-so-humble opinion, that was largely the result of, rather than the cause of, many of her issues, the largest one being, obviously, the blood sugar dysregulation and the large weight gain she experienced several years ago when she started injecting insulin. Most doctors saw her as some anonymous fat lady, rather than someone’s wife and mother. Instead of digging deeper with her during an appointment to address underlying factors, many of these doctors dismissed her with no suggestions or advice other than to lose weight. Yes, losing weight could have helped, but someone could have explained to her what was likely making her put on the excess weight in the first place, and addressing those dietary and hormonal factors would likely have gone a lot further toward preventing so much of what happened down the line. Telling someone to lose weight and showing them the door is not practicing medicine. I don’t know if hearing accurate information regarding the influence of diet on blood sugar and weight from a medical doctor (as opposed to her kid...) would have made any difference to my mother, but it would’ve been nice if someone had at least friggin’ tried. (And yet, it’s just as well they didn’t. The recommendations would likely have been for a low-fat, low-calorie diet, with lots of whole grains and fruit… *Headsmack.*)
My mother didn’t use this kind of treatment as an excuse for avoiding doctors, but thousands of other people do. If you are at all familiar with the “health at every size” movement, then you know there are thousands of heavier people who are summarily dismissed and/or discriminated against by healthcare professionals because they are automatically seen as weak-willed, greedy, lazy, slothful gluttons, whose only problem is that they refuse to put down the ice cream and pick up a barbell. This makes me absolutely furious. (Review my thoughts on the mostly unhelpful concepts of willpower and discipline [at least as they relate to diet and exercise] here and here.) People with serious medical conditions refrain from visiting doctors because they’re afraid they’ll be judged or treated poorly. Or, like my mother, everything—everything—from a broken arm to an ingrown toenail—will be blamed on body weight, and doctors won’t even bother looking for any other explanations. I’ve said it before: In our politically correct times, overweight people are the last acceptable targets. But nobody should be a target at the doctor’s office.
And now that I think about it, “altruism” isn’t really the right word for what I’m trying to say. I’m trying to say, if you or someone you care about has put off doing something about their health (or their weight) because they anticipate shoddy treatment or being subjected to cruel stereotypes, I can promise you I am not that kind of nutritionist. I think that in the posts I wrote about my history with diet and exercise (parts 1, 2, and 3), and the two about discipline and willpower, I made it abundantly clear that I do not associate body size with anyone’s morals or worth and dignity as a human being. I know only too well how doing “all the right things” can lead you to the opposite of where you intended to go, weight-wise. And I’ve known all along (even if I once found it hard to apply to myself) that respect for someone does not come from their waist circumference.
My consultations are a judgment-free zone. They are a safe place where clients—males, females, underweight, overweight, younger, older—can be honest with me about what they eat. They can be honest because I’m honest. A late night cookie binge? Been there. Pulled junkfood out of the garbage after throwing it away so you could sneak a few more bites? Been there, too. So again, if you or someone you care about have/has been putting off talking to a nutritionist because you’re afraid it’ll be someone who’s been thin all their life and couldn’t possibly relate to you or your struggles, maybe now is the time to talk to one, and maybe I’m the one you’re looking for.
And the final bit of this is for the “manly men” out there, and the women who are sick of counting calories, points, and carbs, and weighing, measuring, and logging every damn morsel of food that passes their lips so at the end of the day they can see how “good” they’ve been. I like to think of myself as the “Anti-Nutritionist.” What I mean by that is, I basically encourage people to eat all the things they think they’re not supposed to. (Kaalya Daniel already trademarked “The Naughty Nutritionist,” which is pretty brilliant.) Bacon, sausage, egg yolks, red meat, whole milk—or even better, heavy cream! Butter, coconut oil, beef tallow, lard. It’s the reason I created a special page for men. If you know a guy who’s loath to make an appointment with a nutritionist because he assumes he’s going to be told to give up his beloved steak, you know I am not that gal. Burgers? He can have ‘em…but he might have to ditch the bun. ;-) Tofu and bean sprouts? How about roast chicken—with the crispy skin!
As for the women, we all know a few who subsist on fat-free muffins, Lean Cuisines, Special K cereal, and skinny soy lattes, and somehow still manage to muster the energy to spend 45 minutes on an elliptical machine—and they can’t figure out why they’re not losing fat, and in fact, might have gone up a few sizes. I want to reach these women.
I’ve been wanting to find a politically correct way to market myself to the people who would ordinarily do anything they could to avoid seeing a nutritionist. Obese folks. People who have been dismissed by doctors. People who are close to giving up on themselves, because conventional healthcare has already given up on them. Good nutrition and healthy diets are not what they think, and those of you who eat low-carb, Paleo, or Primal-ish can back me up on that. Starvation not necessary! Long, torturous cardio sessions not required! Delicious food allowed! Fat allowed! Cholesterol allowed! Bullshit banned!
I'd also love to talk with people who aren't quite ready to "go Paleo" or do full-bore low-carb. Those of us in this ancestral health community tend to think we need to be all-or-nothing when it comes to diet and lifestyle, but thousands (possibly millions) of people out there are living proof that even modest changes can have a big impact. My father is one example. He is certainly not on a ketogenic diet, but he's already lost weight and his blood sugar control is vastly improved. We have our own versions of myopia: the people we hear stories from on various forums and comment threads are often people at their wit's end--people whom conventional medicine has failed over and over again. People who needed intense interventions, like the GAPS™ diet, an anti-candida protocol, or a parasite cleanse. We tend to think everyone needs to be gluten-free, or that everyone has a FODMAP intolerance, or is hypothyroid. We forget that, for the vast majority of people out there, big, big improvements can come from going just "most of the way." Cutting way back on grain, but maybe not eliminating it entirely. Cutting out sugar for the most part, but having a bit of something here and there when they really want it. Not everyone has major hormonal imbalances. Some people really do need to just drop the soda. And not everyone needs to sprint or do CrossFit. For the couch potato just starting out, heck, a walk around the block is a step up! Simply walking is one of the very best things any of us can do--for physical and mental health.
So if someone out there is hesitating on seeing a nutritionist because they think they're going to have to give up everything they love, forever, I'm not that gal, either. Baby steps are okay. Slow baby steps are better than no steps.
I can’t help my mother now.
Help me help someone else.
Please feel free to pass this along if you recognize someone you care about in the people I described above. And if you recognize yourself, what are you waiting for? My mother’s gone. You’re still here. Do something to keep it that way. Get Tuit.
Remember: Amy Berger, M.S., NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition.